Obesity Flashcards by Kelsey Fuller

What is the primary factor in the development of obesity?

Genotype

How well did you know this?

Not at all

Perfectly

decreased activity, ease of increased caloric intake, socialization, age, sex, race and economic status are what factors in the development of obesity?

Environment

How well did you know this?

Not at all

Perfectly

T/F: Adipose tissue is considered an organ

True

How well did you know this?

Not at all

Perfectly

____ Leading Cause of preventable death
(10% - 50% greater chance of death from all causes)

Affects ___ of adults in America
35% have BMI > 30

2nd

3/4

More stats on slide 3

How well did you know this?

Not at all

Perfectly

Calculation for BMI

Weight(kg)/height(m2)

(Weight[lbs}/Height[in2]) X 703

How well did you know this?

Not at all

Perfectly

What are the BMI classes

25-29.9 	Overweight
30-34.9	Obese Class I
35-39.9	Obese Class II 
40-44.9	Obese Class III/Morbidly Extreme Obese
>45	Obese Class IV/Severe Obesity

How well did you know this?

Not at all

Perfectly

Calculation for ideal body weight (IBW)

Broca’s Index

Male = Height(cm) – 100
Female = Height(cm) – 105

How well did you know this?

Not at all

Perfectly

Calculation for lean body weight

IBW x 1.3

How well did you know this?

Not at all

Perfectly

Lean body weight is 30% higher than IBW, why?

due to extra muscle mass developed to carry extra weight

How well did you know this?

Not at all

Perfectly

Adipose Tissue: Major physiologic function

Secretes

protein

How well did you know this?

Not at all

Perfectly

Adipose Tissue: Major physiologic function

Endocrine organ -

readily convertible and usable energy

heat insulation

How well did you know this?

Not at all

Perfectly

Adipose Tissue: Major physiologic function

Liver fat metabolism - why is this important?

because all cells contain some unsaturated fats synthesized by the liver

Degradation of fatty acids into usable units of energy
Synthesis of triglycerides from carbohydrates and proteins
Synthesis of other lipids from fatty acids (particularly cholesterol and phospholipids)

How well did you know this?

Not at all

Perfectly

What is android distribution?

Central or abdominal visceral

Apple shaped

How well did you know this?

Not at all

Perfectly

In the android distribution, waist/hip ratio is greater than ___ in men and ____ in women.

0.85 men
0.92 women
Correlated with higher risk of comorbidities

How well did you know this?

Not at all

Perfectly

What is gynecoid distribution?

Gluteal femoral or peripheral

Pear shaped

How well did you know this?

Not at all

Perfectly

Which type of obesity is associated with greater amount of comorbidities?

Android

heart disease, DM, HTN, dyslipidemia, death

How well did you know this?

Not at all

Perfectly

What is gynecoid obesity associated with?

Varicose veins, joint disease

How well did you know this?

Not at all

Perfectly

Cardiac pathophysiology:
Increased metabolic demand from..
Increased Cardiac Output of ___ for each kg of fat

fat organ

0.1 L/mi

How well did you know this?

Not at all

Perfectly

Cardiac pathophysiology:
Increased ____ and increased ____
For every ____ of fat = 25 miles of neovascularization
Increase ____ + _____ = HTN

Vessels and volume

13.5 kg

Increase volume + RAA activation = HTN

How well did you know this?

Not at all

Perfectly

Cardiac pathophysiology:

Increased workload to meet demand has what effects

Increased CO, O2 consumption, CO2 production

Cardiomegaly, atrial and biventricular dilatation and hypertrophy

How well did you know this?

Not at all

Perfectly

Is CAD a dependent or indépendant factor with obesity?

independent

Definition of HTN in obesity

SBP > 140, DBP > 90, or both

2 times risk in obesity

Why is there a 2X risk of HTN in obesity?

Increased blood viscosity
Hyperinsulinemia
Increased mineralocorticoids
Sodium reabsorption
Compression of kidneys
Impaired sodium excretion
RAA activation

Respiratory pathophysiology

Why is there decreased compliance?

Pressure from abdominal, diaphragmatic , and thoracic fat

What is the F/V loop pattern?

Restrictive

Inhibited lung inflation leads to Decreased: Increased: No change:

Decreased: FRC, ERV, VC, TLC Increased: dead space No change: RV, CC, FVC, FEV1

Why is there a decreased FRC to < closing capacity?

Increased dead space, vq mismatch, shunting, hypoxemia

What else does obesity lead to with respiratory?

Hypoventilation, hypercarbia, acidosis

OSA rates are ____ portion to BMI

directly

Risk factors for OSA in obesity

BMI > 30 abdominal fat distribution large neck girth

Definition of OSA

Excessive episodes of apnea (10 seconds) and hypopnea Estimated that 80%-95% are undiagnosed

How do episodes of apnea work in OSA

Obstruction --> hypoxia and hypercarbia --> surge of muscles to open airway --> period of hyperventilation --> reverses hypercarbia --> normal breathing --> start all over

In OSA, > 5 episodes per hour or 30 per night | this will lead to what?

Hypoxia, hypercapnia, systemic and pulmonary hypertension, and cardiac arrythmias

In pre-op, what questions should you ask about sleep apnea?

ask about sleeping patterns, snoring or apnea, arousals, diurnal sleepiness

What is the gold standard test for OSA

polysomnography (PSG)

STOP-BANG

``` Snoring Tiredness Observed apnea High BP BMI (greater than 35) Age (greater than 50) Neck circumference (>40cm/15.75in) Gender (male) ```

Surgery centers should not do patients with a BMI >

What is obese hypoventilation (pickwickian syndrome)?

Inappropriate and sudden somnolence, OSA, Hypoxia, Hypercapnia, arterial hypoxemia, cyanosis-induced polycythemia, respiratory acidosis, pulmonary hypertension, Right sided heart failure

How does pickwickian lead to right sided heart failure

HPV --> pulmonary HTN --> cor pulmonale

GI risks with obesity

GERD, gallstones, pancreatitis Fatty liver disease – 3% develop cirrhosis NAFLD (non-alcoholic fatty liver disease)

DM risk with obesity

80% of NIDDM pts are obese | Risk linear to BMI

Metabolic syndrome with obesity

Glucose intolerance, DM2, HTN, dyslipidemia, CVD | Cardiovascular risk 50%-60% above normal

Ortho risk with obesity

Osteoarthritis from mechanical stress

How much of pediatric population is considered obese?

16.9% age 2-19 considered obese Weight for height ratio > 90% BMI > 95%

Complications with obesity and pregnancy correlate more with _____

pre-pregnancy obesity Gestational DM, preeclampsia, preterm labor, c-section, postpartum hemorrhage, infection, PIH (pregnancy-induced hypertension), macrosomic infants Double 1st 6 weeks miscarriage

Is the complication risk in pregnancy increased or decreased after bariatric surgery?

increased

What are the altered body compositions for pharmacology in obese patients?

Increased Vd Increased blood volume Decreased total body water Alterations of protein binding & lipophilicity of drug

Ideal Body Weight vs. Total Body Weight Meds low lipophilicity = Meds high lipophilicity = inhaled anesthetic

IBW TBW most of the time (digoxin, remifentanil, procainamide) sevo and des

Pharmacokinetic changes with obesity Increased: Decreased:

Increased: fat mass, C.O., blood volume, lean body weight, renal clearance, volume of distribution of lipid soluble drugs Decreased:total body water, pulmonary function Changes in plasma binding, abnormal liver function (Pg 1007)

``` GA induction - ___% reduction in FRC ____ achieves improvement in FRC and arterial O2 tension, may decrease CO and O2 delivery ____ ml/kg IBW for volumes Intermittent manual ____ may help FRC ```

50% PEEP 6-10 “sighs”

In obese patients, there is an increased ____ BUT proportionately decreased _____

total body volume | Estimated blood volume

What EBV is used for obese patients

45-55 ml/kg